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      Gender-based discrimination and unprotected receptive anal intercourse among transgender women in Brazil: A mixed methods study

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          Abstract

          Introduction

          Discrimination related to gender identity may directly influence vulnerability to HIV through increased exposure to unprotected receptive anal intercourse (URAI). Little is known about the relationship between gender-based discrimination (GBD) and URAI with stable partners among transgender women.

          Methods

          This mixed-methods research began with a cross-sectional survey conducted between 2014 and 2016 with transgender women in Salvador, the capital city in one of the poorest regions in Brazil. Respondent-driven sampling was used to recruit the study population. GBD was defined through Latent Class Analysis. Additionally, 19 semi-structured interviews with participants were transcribed and analyzed through thematic content analysis.

          Results

          URAI with stable partners was commonly reported (37.3%). GDB was positively associated with URAI among stable partners (OR = 6.47; IC 95%: 1.67–25.02). The analysis of the interviews illustrated how GBD impacted transgender women in diverse ways. Experiences with GBD perpetrated by the family often initiated a trajectory of economic vulnerability that led many to engage in survival sex work. The constant experience with GBD contributed to participants feeling an immense sense of trust with their stable partners, ultimately diminished their desire to use condoms. Further, the high frequency of GBD contributed to poor mental health overall, though some participants said engagement in transgender advocacy efforts provided a vital source of resilience and support.

          Conclusion

          Our mixed-method study capitalizes upon the strengths of diverse data sets to produce a holistic understanding of GBD and URAI with stable partners. Furthermore, by confirming the association between greater GBD and URAI, we have demonstrated how GBD can impact condom negotiation in diverse relationships.

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          Most cited references52

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          Sampling and Estimation in Hidden Populations Using Respondent-Driven Sampling

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            Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions.

            Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma.
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              Respondent-Driven Sampling: A New Approach to the Study of Hidden Populations

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                11 April 2018
                2018
                : 13
                : 4
                : e0194306
                Affiliations
                [1 ] Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
                [2 ] Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
                [3 ] Instituto de Humanidades, Artes & Ciências Professor Milton Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
                [4 ] Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
                [5 ] Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
                [6 ] Rand Corporation, Santa Monica, California, United States of America
                University of Westminster, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-3752-0782
                Article
                PONE-D-17-31140
                10.1371/journal.pone.0194306
                5894986
                29641528
                b9993d78-7007-4cd5-a0a6-a728310207cd
                © 2018 Magno et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 August 2017
                : 16 February 2018
                Page count
                Figures: 0, Tables: 4, Pages: 17
                Funding
                Funded by: PhD fellowship granted by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
                Award ID: #1031340
                Award Recipient :
                We are grateful for the support of STI/HIV/Aids and Viral Hepatitis Department of the Brazilian Minister of Health. The HIV/AIDS Reference Center of the Bahia Department of Health (CEDAP/SESAB). Additionally, we appreciate the support of CAPES for the PhD fellowship granted to LM (Grant Number #1031340). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                People and Places
                Population Groupings
                Gender Groupings
                Transgender People
                People and places
                Geographical locations
                South America
                Brazil
                Social Sciences
                Sociology
                Sexual and Gender Issues
                Sex Work
                Biology and Life Sciences
                Psychology
                Gender Identity
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                Psychology
                Gender Identity
                Medicine and Health Sciences
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                Biology and Life Sciences
                Microbiology
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                Microbial Pathogens
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                Custom metadata
                Study dataset named Replication Data for: Gender-based discrimination and unprotected receptive anal intercourse among transgender women in Brazil: A mixed methods study is available from Harvard Dataverse: doi: 10.7910/DVN/D6WFOJ.

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